November 16, 2013

Consumers Don’t Follow Fast Food Calorie Posts When Ordering: Study

A new study from New York University's (NYU) Langone Medical Center reveals that posting the calorie content of menu items at major fast-food chains in Philadelphia, per federal law, does not change purchasing habits or decrease the number of calories that those customers consume.

The new findings, reported at the Obesity Society's annual scientific meeting this week, echo those conducted by the same team among low-income neighborhoods in New York City before and after the July 2008 mandate requiring calorie labels.

"What we're seeing is that many consumers, particularly vulnerable groups, do not report noticing calorie labeling information and even fewer report using labeling to purchase fewer calories," says lead study author Dr. Brian Elbel, assistant professor of Population Health and Health Policy at NYU School of Medicine. "After labeling began in Philadelphia, about 10 percent of the respondents in our study said that calorie labels at fast-food chains resulted in them choosing fewer calories."

The Patient Protection and Affordable Care Act, as part of an effort to encourage people to make healthier food choices, mandates that restaurant chains with 20 or more locations across the nation must post the caloric content of all regular food and drink items on their menu board or printed menus.

Real world studies that support the calorie labeling, however, provide very limited scientific evidence. Additionally, scientists have little understanding about how calorie labels will impact different populations. More than one-third of Americans are affected by obesity, with low-income, urban neighborhoods hit the hardest.

"Studies have not generally examined whether labeling is more or less effective for particular subgroups," says Dr. Elbel.

In the wake of the new legislation, the research team set out to assess the impact of calorie labels at fast-food chains. For the Philadelphia study, the team collected receipts from more than 2,000 customers, ages 18 to 64, who visited McDonald's and Burger King restaurants during lunch or dinner before and after February 2010, when the calorie-label law went into effect in Philadelphia.

Each customer was also given a short questionnaire, which asked how often they had visited "big chain" fast food restaurants in the last week; whether they noticed calorie information in the restaurant; and if so, whether they used the information to purchase more or less food than they otherwise would have at the restaurant.

The scientists employed a professional survey firm to simultaneously conduct a random phone survey of residents within the city limits of Philadelphia. Participants between the ages of 18 and 64 were asked whether they had consumed any "big chain" fast food within the last three months. If so, they were asked an additional set of questions about how often they eat fast food, along with demographic questions and their height and weight.

Only 34 percent of McDonald's customers noticed the labels posted to menu boards, according to the findings, compared to 49 percent of Burger King customers. Less educated participants (high school or lower) were less likely to notice the labels, and some reported eating fast food more than five times a week -- before and after the labels went into effect. The team found no decrease in visiting fast food restaurants reported after calorie labeling began in Philadelphia.

The team also surveyed customers of both chains in Baltimore, where the calorie labels are not mandated, to provide a control sample. Approximately 70 percent of the customers in both cities were African American.

"We found no difference in calories purchased or fast-food visits after the introduction of the policy," says Dr. Elbel. "Given the limits of labeling reported here and in other studies, it's clear that just posting calories is often not enough to change behavior among all populations. We need to consider other, more robust interventional policies in places where obesity is most prevalent."